1. Registry Support for an Immunization Program – The PROW Project National Immunization Conference March 17, 2003 Bill Brand, Minnesota Dept. of Health Vice-President, AIRA

2. What is the purpose of PROW? To identify ways registries can effectively and integrally support the other core program components of an immunization program. To identify ways registries can effectively and integrally support the other core program components of an immunization program. To encourage and support adoption of those activities by all registries. To encourage and support adoption of those activities by all registries.

3. What are the products of PROW? Standards of Excellence in each of six program areas: Standards of Excellence in each of six program areas: AssessmentAssessment Consumer InformationConsumer Information Provider Quality AssuranceProvider Quality Assurance Service DeliveryService Delivery SurveillanceSurveillance Vaccine ManagementVaccine Management Dynamic peer learning and support Dynamic peer learning and support

4. PROW Standards of Excellence Comparable to Best Practices Comparable to Best Practices Standards as a ceiling to shoot for versus a floor or set of minimum requirements Standards as a ceiling to shoot for versus a floor or set of minimum requirements Concrete and tangible Concrete and tangible Organized by Core Program Components. Organized by Core Program Components. Cross-referenced to recommended activities in the IPOM Cross-referenced to recommended activities in the IPOM

5. PROW Standards of Excellence Organized into three levels, from relatively easy to implement to challenging/resource intensive Organized into three levels, from relatively easy to implement to challenging/resource intensive Useful for: Useful for: Identifying enhancementsIdentifying enhancements Upgrading your current applicationUpgrading your current application Developing requirements for a new application or RFPDeveloping requirements for a new application or RFP Seen as an essential companion to minimum registry functions (NVAC), IPOM, and the new certification process. Seen as an essential companion to minimum registry functions (NVAC), IPOM, and the new certification process.

6. What can the PROW standards do for you? Greater integration and synergy across your staff/teams Greater integration and synergy across your staff/teams More efficient use of 317 and other funds. More efficient use of 317 and other funds. More fully functional, highly featured registry application More fully functional, highly featured registry application Meet user needs in a more seamless way Meet user needs in a more seamless way

7. Registries Provider QA Registry Support of Core Program Components

8. Provider Quality Assurance Level I: Level I: Export to CASA or otherwise use registry data as part of AFIX visits. Export to CASA or otherwise use registry data as part of AFIX visits. Use registry data to highlight general or practice-specific practice issues that can be incorporated into provider trainings, newsletters, or a “tip-of-the-month” web link. Use registry data to highlight general or practice-specific practice issues that can be incorporated into provider trainings, newsletters, or a “tip-of-the-month” web link.

9. Provider Quality Assurance Level II: Level II: Highlight invalid doses when displaying a history. Highlight invalid doses when displaying a history. Use registry data to prioritize AFIX or VFC site visits. Use registry data to prioritize AFIX or VFC site visits. Use the registry to track series completion for children born to surface antigen-positive moms. Use the registry to track series completion for children born to surface antigen-positive moms.

10. Provider Quality Assurance Level III: Level III: Be able to display the reason for an invalid dose. Be able to display the reason for an invalid dose. Include HBV and HBIG data fields in birth records or other mechanisms, and regularly upload to the registry. Include HBV and HBIG data fields in birth records or other mechanisms, and regularly upload to the registry.

11. Registries Provider QA Vaccine Management Registry Support of Core Program Components

12. Vaccine Management Level I: Level I: Use the registry to direct users to information on vaccine storage and handling. Use the registry to direct users to information on vaccine storage and handling. Incorporate messages about the importance of proper vaccine management into registry materials and training. Incorporate messages about the importance of proper vaccine management into registry materials and training.

13. Vaccine Management Level II: Level II: Support a vaccine inventory feature capable of adjusting doses due to wastage or transfer. Support a vaccine inventory feature capable of adjusting doses due to wastage or transfer. Generate a doses administered or other report(s) to support vaccine accountability activities. Generate a doses administered or other report(s) to support vaccine accountability activities. Capture VFC eligibility status and generate annual reports. Capture VFC eligibility status and generate annual reports.

14. Vaccine Management Level III: Level III: Incorporate a feature that alerts users to lots due to expire or already expired. Incorporate a feature that alerts users to lots due to expire or already expired. Incorporate a link to VACMAN for automated ordering as supplies run low. Incorporate a link to VACMAN for automated ordering as supplies run low. Incorporate a call-back feature for shots deferred due to shortages. Incorporate a call-back feature for shots deferred due to shortages.

15. Registries Provider QA Vaccine Management Surveillance Registry Support of Core Program Components

16. Surveillance Level I: Level I: Provide histories to investigators Provide histories to investigators Level II: Level II: Track adverse events Track adverse events Show which provider gave what shot, in case investigators need to F/U Show which provider gave what shot, in case investigators need to F/U Link to VAERS and to NEDSS Link to VAERS and to NEDSS

17. Registries Provider QA Vaccine Management AssessmentSurveillance Registry Support of Core Program Components

18. Assessment Level I: Level I: Generate coverage and exemption rates on behalf of schools. Generate coverage and exemption rates on behalf of schools. Conduct, supplement, or verify population coverage and exemption reports. Conduct, supplement, or verify population coverage and exemption reports. Generate reports, or export to CASA, to identify geographic or demographic PONs. Generate reports, or export to CASA, to identify geographic or demographic PONs.

19. Assessment Level II: Level II: Use registry data for adult immunization assessments Use registry data for adult immunization assessments Enroll LTC facilities for assessing pneumococcal coverage Enroll LTC facilities for assessing pneumococcal coverage Provide registry access to Medicaid and MCOs Provide registry access to Medicaid and MCOs Track occupational vaccines Track occupational vaccines

20. Assessment Level III: Level III: Use GIS to monitor trends in specific geographic areas. Use GIS to monitor trends in specific geographic areas. Assess HBV coverage at STD, HIV, correctional, or other settings serving high risk populations Assess HBV coverage at STD, HIV, correctional, or other settings serving high risk populations

21. How do we use the PROW standards? We include a self-assessment worksheet that includes all the Standards of Excellence. We include a self-assessment worksheet that includes all the Standards of Excellence.

23. How do we use the PROW standards? We include a self-assessment worksheet that includes all the Standards of Excellence. We include a self-assessment worksheet that includes all the Standards of Excellence. Can either rate where you are today in terms of each standard or how important each standard is to where you want to go. Can either rate where you are today in terms of each standard or how important each standard is to where you want to go. The standards help identify desirable enhancements/features. The standards help identify desirable enhancements/features.

24. Areas registries can be most useful Coverage assessments Coverage assessments Reminder-recall Reminder-recall Provider visits/AFIX Provider visits/AFIX Vaccine safety and management Vaccine safety and management For web-based registries: provider and consumer education For web-based registries: provider and consumer education Survey of Program Managers and Registry Managers, 2002

25. Program Managers Meeting January 2003 Lunch roundtables to discuss benefits, barriers, and recommendations Lunch roundtables to discuss benefits, barriers, and recommendations High level of support High level of support PROW as a way to secure additional funding, identify enhancements, increase registry credibilityPROW as a way to secure additional funding, identify enhancements, increase registry credibility Implementation will be successful if: Implementation will be successful if: AIM and NIP remain engagedAIM and NIP remain engaged Clarify uses of the standardsClarify uses of the standards Include in annual registry reportInclude in annual registry report Get other endorsements (CMS, NVAC)Get other endorsements (CMS, NVAC)

26. NVAC Resolution, February 2003 The NVAC believes the growing maturity of registries demonstrates they can play an increasingly critical role within immunization programs. In particular, recent efforts of AIM, AIRA, and the NIP have highlighted ways in which registries can provide important support to other core program strategies…. The NVAC believes the CDC should continue working with its partners to identify and disseminate best practices for registry support of an immunization program, such as found in the PROW standards.

27. What’s next? PROW Implementation Plan PROW Implementation Plan Committee of Program and Registry Managers, NIP staffCommittee of Program and Registry Managers, NIP staff Identify pilot sites; evaluate resultsIdentify pilot sites; evaluate results Add questions on PROW to the annual registry reportAdd questions on PROW to the annual registry report Peer learning/mentoring groupPeer learning/mentoring group Best practices resource kitBest practices resource kit Communication, education, supportCommunication, education, support Continual revising and growing of the Standards based on their use and the growing maturity of registries. Continual revising and growing of the Standards based on their use and the growing maturity of registries.

28. For more information… www.immregistries.org or Bill Brand Minnesota Department of Health bill.brand@health.state.mn.us

29. Registries Provider QA Vaccine Management AssessmentSurveillance Consumer Education Registry Support of Core Program Components

30. Consumer Information Level I: Level I: Use registry notification or promotional materials to include general immunization information. Use registry notification or promotional materials to include general immunization information. Level II: Level II: Generate or link to a variety of consumer materials, including VISs Generate or link to a variety of consumer materials, including VISs

31. Consumer Information Level III: Level III: Provide direct, secure, on-line consumer access Provide direct, secure, on-line consumer access Send reminder-recall notices through e-mail, automatically attaching the appropriate VISs for the next visit Send reminder-recall notices through e-mail, automatically attaching the appropriate VISs for the next visit

32. Registries Provider QA Vaccine Management AssessmentSurveillance Consumer EducationService Delivery Registry Support of Core Program Components

33. Service Delivery Level I: Level I: Enable WIC access for assessing UTD status of WIC clients. Enable WIC access for assessing UTD status of WIC clients. Enable school access for recording shots given on site. Enable school access for recording shots given on site.

34. Service Delivery Level II: Level II: Use registry data to identify seriously immunization-delayed individuals so that outreach can be conducted Use registry data to identify seriously immunization-delayed individuals so that outreach can be conducted Identify children without a medical home Identify children without a medical home

35. Service Delivery Level III: Level III: Use enrollment rosters from child care facilities to ID children not UTD. Use enrollment rosters from child care facilities to ID children not UTD. Use electronic WIC rosters to generate individual immunization reports for cert/recert Use electronic WIC rosters to generate individual immunization reports for cert/recert Recruit LTC, tracking pneumococcal coverage and conducting educational outreach to those with low levels Recruit LTC, tracking pneumococcal coverage and conducting educational outreach to those with low levels